Urethral stricture is a condition when the urethranarrows, so that the flow of urine becomes blocked. Urethral strictures are common in adult men. However, this condition can also occur in newborns and women, although it occurs less frequently.
The urethra or urinary tract is the tube that carries urine from the bladder to the outside of the body. In other words, the urethra is needed to get rid of waste products from the body's metabolism.
If a urethral stricture occurs, the flow of urine becomes blocked. As a result, various health problems will appear, such as inflammation in the urinary tract.
Causes of Urethral Stricture
A stricture or narrowing of the urethra is caused by the appearance of scar tissue (scars) in the urinary tract. These scars can appear as a result of the following:
- Medical procedures performed by inserting an instrument into the urethra, such as urinary endoscopy or brachytherapy in prostate cancer patients
- Long-term use of a catheter
- Surgical removal of the prostate gland
- Radiotherapy or radiation therapy
- Congenital abnormalities of the urethra
- Injury to the urethra, penis, groin, or pelvis
- Infection or inflammation of the prostate (prostatitis)
- Sexually transmitted infections, such as gonorrhea and chlamydia
- Urethritis or inflammation of the urethra that recurs frequently
- Benign prostatic hyperplasia (benign prostate enlargement)
- Urethral cancer or prostate cancer
Urethral Stricture Symptoms
Some of the symptoms commonly experienced by patients with urethral stricture are:
- Weakened urine flow or reduced urine output
- Dissatisfaction after urinating (like there's still something left)
- The flow of urine that comes out is like being sprayed
- Difficulty, having to strain, or feeling pain when urinating
- Urination becomes more frequent, but little by little
- Often feel like you need to pee
- Can't hold my pee
- Discharge other than urine from the urethra
- Urine color is a bit dark
- There is blood in the urine (hematuria) or sperm
- Pain in the pelvis or lower abdomen
- Swollen penis
When to go to the doctor
Immediately consult a doctor if you experience symptoms of urethral stricture to prevent urinary retention, i.e. urine cannot come out of the bladder. If it occurs in the long term, urinary retention can cause various complications and permanent disorders of the bladder and kidneys.
Urethral Stricture Diagnosis
The doctor will first ask the patient's symptoms and medical history. After that, the doctor will perform a physical examination, to look for signs of enlargement or swelling of the prostate.
To confirm the diagnosis, the doctor will carry out supporting examinations, such as:
- Measurement of urine flow rate when the patient urinates
- Urine test, to check for possible infection and the presence of blood in the urine
- Urethrographym retrograde, namely imaging using X-rays, to see how severe the narrowing is
- Tests for sexually transmitted infections, to check for possible gonorrhea and chlamydia infections
- Pelvic ultrasound, to check the amount of urine remaining in the bladder after urinating
- Cystoscopy, which is done by inserting a small camera tube through the urethral opening, to examine the condition of the urethra and bladder
Urethral Stricture Treatment
There are several treatment methods that doctors can use to treat urethral strictures, namely:
1. Urethral dilation
Urethral dilation is done by inserting a small wire down the urethra to the bladder. This procedure needs to be repeated several times with the size of the cord getting closer and closer to the size of the normal urethra.
2. Urethrotomy
A urethrotomy is a procedure performed to locate the scar tissue, by inserting a small tube with a camera into the urethra. Once the location of the scar tissue is known, the doctor will insert a small scalpel to cut the tissue, so that the urethra can widen again.
3. Urethroplasty
Urethroplasty is a procedure to remove the narrowed tissue and reshape the urethra. Urethroplasty is performed on severe and longstanding urethral strictures.
4. Installation stent
Installation stent (elastic tube the size of a normal urethra) or a catheter permanently serves as an outlet for urine. This procedure is performed on severe urethral strictures.
5. Urine flow deflection
The deflection of the flow of urine is done by making a hole in the stomach as a new way for urine to come out. This action is done if the condition of the bladder has been damaged or needs to be removed.
In addition to the various procedures above, the doctor will also prescribe antibiotics to prevent urinary infections. Antibiotics will be given for a long time, until the urethral canal has dilated again.
Urethral Stricture Complications
As previously explained, urethral stricture causes the flow of urine that should be out to be blocked. In other words, some of the urine collects in the bladder. The rest of the urine that cannot be excreted is at risk of causing complications such as:
- Bladder infection
- prostate gland infection
- Kidney infection
- Collection of pus (abscess in the urethra)
- Further damage to the urethra
- Urethral cancer
- Fistula (new passage) that forms from the urethra to the skin around the anus
Urethral Stricture Prevention
One of the causes of urethral stricture is a sexually transmitted infection. Therefore, it is highly recommended to practice safe sex as a preventive measure against urethral stricture.